Health Assessment Final Flashcards

Question

Acromioclavicular Joint

Answer 1

•Articulation between the acromion process and the clavicle

Answer 2

Articulation between the manubrium of sternum and clavicle

Answer 3

* Articulation between the mandible and temporal bone in the cranium * Hinge action opens and closes mouth * Gliding action permits lateral movement, protrusion, and retraction of the mandible

Answer 4

•Spine * •Cervical vertebrae * •Thoracic vertebrae * •Lumbar vertebrae * •Sacral vertebrae

Answer 5

Everywhere but the sacral vertebrae

Answer 6

Nucleus of fibrogelatinous

Answer 7

joints that glide slightly over each other's surfaces

Answer 8

Flexion and extension occur between the skull and C1; rotation occurs between C1 and C2

Answer 9

* Articulation between the acetabulum and the femur * Ball-and-socket joint, permitting movement of the femur on many axes * Three strong ligaments support joint * Three bursae reduce friction in the hip

Answer 10

* Articulation of the femur, tibia, and patella * Hinge joint, permitting movement (flexion and extension) between the femur and tibia on one plane * Articulation of the femur, tibia, and patella * Fibrocartilaginous disks (medial and lateral menisci) cushion the tibia and femur and are attached to the tibia and the joint capsule

Answer 11

Collateral ligaments

Answer 12

•Two cruciate ligaments cross obliquely within the knee, adding anterior and posterior stability

Answer 13

The **_suprapatellar bursa_** separates the patella, quadriceps tendon, and muscle from the femur

Answer 14

* Articulation of the tibia, fibula, and talus * Hinge joint that permits flexion and extension (dorsiflexion and plantar flexion) in one plane * Additional joints in the ankle, the talocalcaneal joint (subtalar) and transverse tarsal joint, permit it to pivot or rotate (pronation and supination)

Answer 15

* Articulations of the foot between the tarsals and metatarsals, the metatarsal and proximal phalanges, and the middle and distal phalanges * Flexion and extension

Answer 16

* Long bones increase in length and thickness throughout childhood * Cartilage in smaller bones ossifies * Ligaments are stronger than bones until adolescence * •Fractures common * Muscle fibers lengthen * Skeletal system grows

Answer 17

•Rapid growth in puberty results in: * •Decreased strength in epiphyses * •Increased risk for injury * Bone growth completed about age 20 * Peak bone mass achieved at age 35

Answer 18

Low back pain Joint pain, stiffness, swelling, redness, Decrease ROM, trauma Muscle pain (Cramp) or weakness Inflammatory or infectious joint pain Joint pain with systemic features such as fever, chills, rash, anorexia, weight loss, weakness Joint pain with symptoms from other organ systems

Answer 19

Algorithm for Low Backpain

Answer 20

* Observation: * Palpation * AROM (active Range of Motion) if abnormal PROM (Passive ROM) * Muscle strength (observe during AROM, and against resistance)

Answer 21

* If the joint is painful assess it last. * So first assess joint on the opposite side if available * Then proximal and distal joints on the same side * Finally the painful/pathologic joint * •For instance: Left elbow pain * •Assess right elbow * •Assess left shoulder and wrist * •Assess Left elbow and contrast your findings with your assessment from the right elbow

Answer 22

Active / Passive ROM

Answer 23

* Bilateral symmetry * Hypertrophy * Atrophy * Fasciculations * Spasms

Answer 24

Use a gonimeter to determine ROM where there is an increased or decreased ROM

Answer 25

contralateral

Answer 26

•Graded 0 (no voluntary contraction) to 5 (full muscle strength) * •Weakness may result from: * •Disuse atrophy * •Pain * •Fatigue * •Overstretching

Answer 27

* Observation for abnormalities * Palpate * •Pain * •Crepitus, locking, and popping •Assess ROM * •Open and close * •Lateral movement * •Protrusion and contraction * •Assess muscle strength * •Temporalis * •Masseter

Answer 28

•Inspect * •Head alignment * •Symmetry of muscles and skinfolds •Palpate * •Tone * •Symmetry * •Tenderness * •Spasm Picture is AROM

Answer 29

·Congenital ·Neuromuscular ·Idiopathic

Answer 30

Thoraco-lumbar scoliosis is more common in peds and younger adults

Answer 31

Lumbar scoliosis more common in middle age and older adults ![]()

Answer 32

What is the Cervical Spine: Spurling Test ## Footnote * Passively extend and rotate the patient’s neck to the affected side. Slowly start applying axial pressure by pressing down on the top of the patient’s head * Radicular pain extending down the arm on the same side as the test is considered a positive test.

Answer 33

* Have the patient lie supine. Lift one leg at a time to 90 degrees or as far as the patient can tolerate. Place your other hand on the knee to ensure full knee extension * The test is considered positive if there is pain between 30 and 70 degrees of hip flexion that radiates below the knee. To further confirm neurologic etiology, slightly lower the leg and dorsiflex the foot; this will often also reproduce the radicular symptoms.

Answer 34

Apley Scratch Test The patient attempts to touch the opposite scapula 1) Testing abduction and external rotation 2) Testing adduction and internal rotation

Answer 35

INSPECT - Size, Symmetry, Contour, Dislocation or winging of the scapula PALPATE - Joints, Muscles

Answer 36

What does the drop arm test detect? Detects tears in the rotator cuff, namely supraspinatus

Answer 37

Neer Test ## Footnote * identify supraspinatus impingement * While stabilizing the patient’s scapula, passively forward flex the arm while the arm is in the pronated position * Pain and apprehension are considered positive tests.

Answer 38

ROM for Elbows ## Footnote * Flexion: expect 160 degrees * Extension: expect 180 degrees * Pronation: expect 90 degrees * Supination: expect 90 degrees

Answer 39

Tennis Elbow * Lateral epicondylitis ( Tennis Elbow) * Gradual onset of pain outside ( lateral portion of the elbow) * At time radiate to forearms * Pain worsened with twisting or grasping movements Opening a jar, shaking hands Cozen’s test: With the elbow stabilized and the hand pronated and in a fist, have the patient extend their wrist against resistance. Pain over the lateral epicondyle is considered a positive test.radial

Answer 40

Golfers Elbow ## Footnote * Gradual onset of pain inside ( medial ) aspect of the elbow). AKA funny bone * Golfer elbow test: * with the elbow stabilized, have the patient supinate their hand and close their fist. Next, have the patient flex their wrist against resistance. * Pain over the medial epicondyle is considered a positive test.

Answer 41

* Flexion of fingers: expect 90 degrees * Hyperextension of fingers: expect 30 degrees * Flexion of wrist: expect 90 degrees * Hyperextension of wrist: expect 70 degrees * Rotation of hand: expect radial motion of 20 degrees, ulnar motion of 55 degrees

Answer 42

◦Pain or numbness of the thumb, index, middle finger especially at night ◦Hand weakness during tasks ◦Weak abduction of the thumb Risk factors: * ◦Repetitive injury * ◦Work related * ◦Diabetes, hypothyroidism, and Arthritis, pregnancy, High BMI, Hypocalcemia

Answer 43

Tinel’s sign: tingling with tapping over the median nerve as it enters the carpal tunnel Aching and numbness = positive sign

Answer 44

Phalen’s sign: numbness or tingling with pressing backs of hands together in acute flexion for 60 seconds Numbness and tingling within 60 seconds = positive sign

Answer 45

* Gradually worsening pain along the radial aspect of the thumb and wrist painful condition due to stenosis of the tendon sheath in the 1st dorsal compartment of the radial aspect of the wrist. * Repetitive motions of the wrist and/or thumb result in microtrauma, metaplastic thickening of the tendons (EPB, APL), and narrowing of the surrounding tendon sheath. * Increased risk in women 30-50, pregnancy, AA, PMH with RA, repetitive activities (golf, fly fishing, racquet, rowing, bicycle, video game, text messages)

Answer 46

De Quervain's Syndrome ## Footnote * Finkelstein test identifies De Quervain’s syndrome * With the forearm stabilized, have the patient grasp their thumb in their fist, then perform ulnar deviation of the hand * Pain over the tendons is considered a positive test. Be sure to slowly deviate the hand, as this test, when positive, can be exquisitely painful.

Answer 47

Has Heberden's Nodes & Bouchards nodes that can also be present in RA and psoriatic arthritic

Answer 48

Osteoarthritis ## Footnote Heberden's nodes are hard or bony swellings that can develop in the distal interphalangeal joints (DIP)

Answer 49

Osteoarthritis ## Footnote Bouchard's nodes are hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints (PIP)

Answer 50

Rheumatoid arthritis It may begin any time in life. Onset: Relatively rapid, over weeks to months Joints are painful, swollen, and stiff. It often affects small and large joints on both sides of the body (symmetrical), such as both hands, both wrists or elbows, or the balls of both feet. \*\*Morning stiffness usually lasts longer than 1 hour. Frequent fatigue and a general feeling of being ill are present.

Answer 51

* •Dupuytren’s contracture is a progressive nodularity and flexion contracture of the palmar fascia and digital flexors in the hand * • slow onset over years and is usually seen in people over the age of 50. can lead to flexion contractures of the MCP and PIP joints * •Risk factors: Tobacco, alcohol, and diabetes are all risk

Answer 52

•Inspect * Symmetry * Size * Gluteal folds

Answer 53

Identifies hip flexor, sacroiliac, or hip intra-articular pathology. FABER stands for Flexion, ABduction, and External Rotation With the patient supine, have them flex, abduct, and externally rotate the hip until the ankle rests upon the contralateral knee. Then, apply downward pressure, moving the knee closer to the table Pain or decreased range of motion is considered a positive test.

Answer 54

FADIR TEST The anterior impingement test or FADIR (Flexion ADDuction Internal Rotation) test is performed by flexing the hip to 90 degrees, adducting across the midline, and maximally internally rotating the hip

Answer 55

Medical sign which indicates increased fluid in the suprapatellar pouch over the patella at the knee joint. So test for knee effusion. To test ballottement the examiner would apply downward pressure towards the foot with one hand, while pushing the patella backwards against the femur with one finger of the opposite hand.

Answer 56

Identifies meniscus pathology mostly tear to lateral or medial meniscus Pain or clicking over the medial or lateral joint lines is considered a positive test.

Answer 57

Plantar Fasciitis / Flat Feet

Answer 58

* congenital condition where the forefoot is adducted, while the heel is in varus * Early treatment will include casting and bracing, with surgery becoming an option around month 3 or 4, though it can be delayed if necessary.

Answer 59

* Gout is an inflammatory arthritis characterized by deposition of monosodium urate * crystals that accumulate in joints and soft tissues, resulting in acute and chronic arthritis, soft-tissue masses called toph Classic presentation of acute gouty arthritis: * Intense pain and tenderness in the 1st metatarsophalangeal joint (podagra) * Can occur in the midtarsal, ankle, or knee joints * Joint may be swollen, warm, and erythematous. * Often awakens patients from sleep due to an intolerance to contact with clothing or bed sheets * There is a rapid onset of intense pain, often beginning in the early morning and progressing rapidly over 12 to 24 hours. * In the absence of treatment, flares can last up to 10 days. * Fever can be present. Redness, swelling, decreased ROM and acute tenderness to the affected joint

Answer 60

Hip Exam for Hip Dysplasia in the newborn Done with the Ortolani maneuver (Abducted in a frog-leg position) Barlow Maneuver Flex hip and knees to 90 degrees (Straight down) Positive: Palpable and audible clunk as the head slips back into the socket

Answer 61

•Inspect * Dorsal kyphosis * Base of support broader (feet more widely spaced) * Reduction in total muscle mass

Answer 62

* Osteoporosis * Disease in which a decrease in bone mass occurs because bone resorption is more rapid than bone deposition * Familial predisposition * More common in Caucasians and Asians than in African Americans and Hispanics * Symptoms: Asymptomatic * Spontaneous fracture * Thoracic kyphosis, poor balance, deconditioning * Loss of height

Answer 63

•midway point to osteoporosis; the bone density is lower than normal but not as severe

Answer 64

Main network of coordination and control for the body Brain Spinal Cord

Answer 65

Carries information to and from the CNS Cranial nerves Spinal nerves

Answer 66

Coordinates and regulates the internal organs of the body Two divisions that balance the impulses of each other are the: Sympathetic division and Parasympathetic division

Answer 67

•Sympathetic division: prods body to action during periods of physiologic and psychologic stress

Answer 68

•Parasympathetic division: functions in a complementary and counterbalancing manner to conserve body resources and day-to-day functions (e.g., digestion and eliminations)

Answer 69

* Skull and vertebrae * Meninges * Cerebrospinal fluid (CSF)

Answer 70

•Three layers of meninges produce and drain CSF

Answer 71

•CSF circulates between an interconnecting system of ventricles in the brain and around the brain and spinal cord, serving as a shock absorber

Answer 72

* Cerebrum * Cerebellum * Brainstem

Answer 73

•Gray outer layer (cerebral cortex) houses the higher mental functions and is responsible for: * General movement * Visceral functions * Perception * Behavior * Integration of functions

Answer 74

* Pathway between the cerebral cortex and the spinal cord * Controls many involuntary functions * The nuclei of the 12 cranial nerves arise from these structures

Answer 75

* Twelve peripheral nerves that originate from brain * Functions * •Motor * •Sensory * •Parasympathetic

Answer 76

Nerve cell bodies

Answer 77

medulla oblongata

Answer 78

Ascending and descending tracts

Answer 79

•The spinal cord * •Extends from brainstem (medulla) to L1-L2 vertebrae * •Contains motor and sensory pathways that exit and enter the cord via anterior and posterior nerve roots and spinal and peripheral nerves

Answer 80

•5 segments: cervical (C1-8), thoracic (T1-12), lumbar (L1-5), sacral (S1-5), coccygeal

Answer 81

Cauda equina at L1-2, where nerve roots fan out like a horse’s tail

Answer 82

* Thirty-one pairs arise from the spinal cord * Exit at each intervertebral foramen * Sensory and motor fibers of each spinal nerve supply receive information in a specific body distribution called a dermatome

Answer 83

* Motor or efferent fibers of the anterior root carry impulses from the spinal cord to the muscles and glands of the body * Sensory or afferent fibers of the posterior root carry impulses from sensory receptors of the body to the spinal cord, and then on to the brain for interpretation by the cerebral sensory cortex

Answer 84

Moro (startle reflex), stepping, palmar and plantar grasp

Answer 85

•At birth, the neurologic impulses are primarily handled by the **_brainstem_** and **_spinal cord_**

Answer 86

Cephalocaudal (head to toe direction) ## Footnote * Head and neck * Trunk * Extremities

Answer 87

* The number of cerebral neurons decreases with aging, but this is not necessarily associated with deteriorating mental function * Vast number of reserve neurons inhibits the appearance of clinical signs * Velocity of nerve impulse conduction declines * •Slowed response time * •Diminished touch and pain perception * •Diminished functions of smell, taste and vision •Normal aging changes increase risk for abnormal findings * •Unsteady gait, increase risk of fall * •Decrease Range of motion * •Diminished appetite

Answer 88

Vertigo Chief complaint - Spinning or sensation of self motion Triggering event - Acute asymmetry of vestibular system. Turning over in bed. Looking up to self. Moving the head Associated symptoms and important historical features - CNS signs or symptoms: dysarthria, headache, diplopia, ataxia, neck pain. Auditory symptoms: hearing loss, tinnitus. Ataxic duration. Nausea, vomiting, unbalanced, oscillation Key physical exam findings * Cranial nerve exam * Gait * Finger to nose exam * HINTS plus exam

Answer 89

Chief complaint - Sense of impending loss of consciousness Triggering event - Orthostatic hypotension upon standing. Reduced cerebral blood flow, decrease cardiac output Associated symptoms and important historical features - * Tunnel vision * Palpitation * Perspiration, pallor * “Almost blacking out” or “almost fainting” Key physical exam findings * Orthostatic Blood pressure and pulse * Cardiac exam for murmur, JVD or S3

Answer 90

Chief complaint - Unstable while seated, standing or walking Triggering event - Dizziness while Walking Associated symptoms and important historical features - * Multi sensory deficit, periphral * Neuropathy * Visual problem * medication Key physical exam findings * Gait * Romberg * Position sense * Sensation * Cranial nerve exam * Finger to nose exam

Answer 91

Chief complaint - Floating, vague, unclear sensation of falling Triggering event - Stress, anxiety, depression, or panic disorder Associated symptoms and important historical features - Multiple somatic complaints. Feeling down or hopeless Key physical exam findings

Answer 92

* Abnormal vital signs * Hemodynamically unstable * Confusion/Impaired mental status * Associated pain * Neurological symptoms * New headache, Diplopia, dysarthria, dysphasia, drop attack, unilateral weakness * Cardiovascular symptoms (chest pain, dyspnea, syncope) * vomiting * Fever * Ataxia (abnormal movement/gait) CAN THERE BE A BLEED SOMEWHERE

Answer 93

Dizziness Algorithm **Vertigo is dizzyness within** **Dizzyness is room spinning** **KNOW THIS ALGORHYTHM**

Answer 94

Tremor Algorithm

Answer 95

Determines vertigo and nystagmus ## Footnote * Results * Positive: * "down" side produces nystagmus and trigger dizziness and is the side causing the positional vertigo * If the right side is being tested (in the "down" position), the eye will rotate in a counterclockwise manner during the rapid phase of nystagmus, with a minor up-beating vertical (toward the forehead) component * If the left side is being tested, the results are similar except the eye rotates clockwise * Negative: * No nystagmus is noted

Answer 96

Occurs with voluntary contraction of muscle Includes postural, isometric and kinetic tremors

Answer 97

Occurs with any form of voluntary movement Includes essential physiologic, cerebellar, dystonic and drug-induced tremors

Answer 98

Occurs with any form of voluntary movement Includes classic essential, cerebellar, dystonic, and drug-induced tremors

Answer 99

Subtype of kinetic tremor amplified as the target is reached Presence of this type of tremor implies that there is a disturbance of the cerebellum or its pathways

Answer 100

Occurs in a body part that is relaxed and completely supported against gravity Most commonly caused by parkinsonism, but may also occur in severe essential tremors

Answer 101

SENSORY Brain Pathway: Mucous membrane of nose to olfactory bulbs Olfactory receptors for sense of smell

Answer 102

SENSORY Brain Pathway: II Retina -\> optic nerve -\> thalamus -\> occipital lobe Retina for sense of sight

Answer 103

MOTOR Brain Pathway: Midbrain -\> eye and eyelid Eye muscles (including eyelids and lens); pupil (parasympathetic division)

Answer 104

MOTOR Brain Pathway: Midbrain -\> eye Eye muscles

Answer 105

MIXED - SENSORY & MOTOR Brain Pathway: V Sensory: Teeth, eye, skin, tongue -\> pons Motor: Pons -\> jaw muscles Transmits nerve impulses to the teeth, eyes, skin, and tongue

Answer 106

MOTOR Brain Pathway: VI: Pons -\> eye Eye muscles

Answer 107

MIXED - SENSORY & MOTOR Brain Pathway: VII Sensory: Tongue -\> pons. Taste buds on the anterior tongue. Motor: Pons -\> facial muscles, Salivary glands, tear glands

Answer 108

SENSORY Brain Pathway: Inner ear -\> pons and medulla Inner ear for sense of balance and hearing

Answer 109

MIXED SENSORY & MOTOR Brain Pathway: (IX) Sensory: Tongue, throat -\> pons. Motor: Pons -\> Salvary gland, Throat muscles. Pharyngeal muscles (swallowing), salivary glands

Answer 110

X - MIXED - SENSORY - MOTOR Brain Pathway: X Sensory: Eardrum, ear canal, throat, heart, lungs, abdominal organs -\> medulla Internal organs, external ear canal, ear drum, and back of throat Motor: Medulla -\> throat and larynx , heart, lungs, abdominal organs

Answer 111

XI - Motor Brain pathway: Medulla -\> throat and larynx, heart, lungs, abdominal organs Internal organs (parasympathetic division), throat muscles (somatic motor division)

Answer 112

MOTOR XII Brain Pathway: Medulla -\> tongue muscles Tongue muscles

Answer 113

Test for visual acuity Test for visual fields Sensory component of the pupillary reflex ONLY SENSORY

Answer 114

•Position yourself in front of the patient. Test the patient's visual acuity, each eye separately covering one at a time. •Snellen's chart. Visual acuity is recorded as a fraction. The numerator indicates the distance (in feet) from the chart which the subject can read the line. The denominator indicates the distance at which a normal eye can read the line. Normal vision is 20/20.

Answer 115

Rosembaum: pocket screener is used at the bedside. Hold the pocket screener at a distance of 12-14 inches. At this distance the letters are equivalent to those on Snellen's chart.

Answer 116

•By confrontation * •Position yourself in front of the patient. * •The nose normally cuts off the medial field of vision. * •Hence, compare the patient's right eye to your left eye and vice versa. * •Instruct the patient to look straight at you and not to move their eyes. * •Compare your field of vision with the subject's. * •Bring your finger from the right field of vision until it is recognized. * •Test one quadrant at a time. * •Wiggle your fingers to see whether the patient can recognize the movement. * •Some like to have the patient count fingers, i.e., 1, 2 or 5. * •Test all four quadrants in a similar fashion. * •When abnormality is detected , would require automated methods of testing in the lab

Answer 117

* Have the patient look at a distant object * Look at size, shape and symmetry of pupils. * Shine a light into each eye and observe constriction of pupil. * Flash a light on one pupil and watch it contract briskly. * Flash the light again and watch the opposite pupil constrict (consensual reflex). * Repeat this procedure on the opposite eye. * Normal: * Pupil size is 3-5 mm in diameter. * They react briskly to light. * Both pupils constrict consensually.

Answer 118

* •Note the alignment of the eyes at rest. * •Ductions: Movement of one eye at a time * •Versions: Both eye movement * •Have the patient follow an object into each of the nine cardinal fields of gaze. * •Note that both eyes move together into each field. * •Eye movements should be smooth and without jerking. * •Eyelids should be gently lifted up by the examiner's fingers when testing downward gaze. * •Jerky, oscillatory eye movements (nystagmus) may be abnormal, especially if sustained or asymmetrical.

Answer 119

Movement of one eye at a time

Answer 120

Both eye movement

Answer 121

•Corneal reflex: patient looks up and away. * Touch cotton wool to other side. * Look for blink in both eyes, ask if can sense it. * Repeat other side tests V sensory, VII moto •Facial sensation: sterile sharp item on forehead, cheek, jaw. * Repeat with dull object. Ask to report sharp or dull. * If abnormal, then temperature [heated/ water-cooled tuning fork], light touch [cotton]. •Motor: pt opens mouth, clenches teeth. * Palpate temporal, masseter muscles as they clench.

Answer 122

Raise eyebrows Tightly close eyes Puff out cheeks Show teeth

Answer 123

Inability to close eyelid Drooping of the mouth Facial nerve Absence of NL fold Absence of other neurological deficits such s/s of stroke

Answer 124

Often linked to exposure to a viral infection. Same viruses that cause; cold sores and genital herpes (herpes simplex) Chickenpox and shingles (herpes zoster) Mononucleosis (Epstein-Barr) Cytomegalovirus infections Respiratory illnesses (Adenovirus) German measles (Rubella) Mumps (mumps virus) Flu (Influenza B) Hand foot and mouth disease (coxsackievirus)

Answer 125

Taste & Swallowing Test tongue for sour and bitter Test gag reflex and swallow

Answer 126

MIXED Swallowing & Speech * Inspect palate and uvula for symmetry * Inspect for swallowing difficulty * Evaluate guttural speech sounds

Answer 127

* Have patient shrug shoulder against resistance and evaluate strength of Trapezius muscle. * Have patient turn head to one side against resistance and evaluate strength and observe contracting sternomastoid muscle

Answer 128

Tongue Movement This nerve tests the bulk and power of the tongue. Tongue will deviate toward the lesion of the brain

Answer 129

CN II - XII grossly intact

Answer 130

Olfactory Smell Odor recognition

Answer 131

Optic Visual acuity Visual fields

Answer 132

Oculomotor Raise eyebrows Extraocular eye movements

Answer 133

Trochlear Eye movement - inward and downward

Answer 134

Trigeminal Chewing Clenching teeth Sensations on forehead

Answer 135

Abducens Lateral eye movements

Answer 136

Facial Facial expressions Taste - anterior 2/3 of tongue Secretion tears and saliva

Answer 137

Acoustic Hearing Equilibrium

Answer 138

Glossopharyngeal Swallowing Gag reflex Taste - posterior third of the tongue Salivary gland secretion

Answer 139

Vagus Speech phonation Swallowing Sensation behind ear Gag reflex

Answer 140

Spinal Accessory Turn head Shrug shoulders

Answer 141

Hypoglossal Tongue movement

Answer 142

Patient stands with feet together and eyes open, then with the eyes closed for 30 - 60 seconds without support Loss of balance when eyes closed is a positive test

Answer 143

* patient to stand for 20 to 30 seconds with eyes closed and both arms straight forward with palms up * clinician taps the arms briskly downward. The arms normally return smoothly to the horizontal position, * loss of position strength, arms will drift sideward or upward, which is a positive test for pronator drift

Answer 144

•Gait – assess gait as patient: * Walks across room * Walks heel-to-toe * Walks on toes then heels * Hops in place

Answer 145

•Assess proprioceptive system including cerebellar function

Answer 146

•Superficial/light touch * Cotton wisp or fingertip •Superficial pain * Broken tongue blade or the point and hub of a sterile needle •Temperature * Tested only when superficial pain sensation is not intact •Vibration * Tuning fork (lower Hz) •Proprioception sensory function * Position of joints * Raise or lower

Answer 147

* Sensory test to evaluate diabetic and peripheral neuropathy * Testing with a 5.07 monofilament should be done on several sites * the patient’s eyes closed, the clinician places the monofilament on several sites of the plantar surface of each foot and one side of the dorsal surface of the foot in a random pattern * pressure for 1.5 seconds to each site * Testing is positive if the patient cannot feel the monofilament indicative of peripheral neuropathy

Answer 148

* Test cognitive ability to interpret sensations * Inability to perform these tests should make you suspect a lesion in: * •Sensory cortex * •Posterior columns of the spinal cord •The primary sensory functions must be intact to perform cortical sensory function * •Always check if primary sensory functions are intact, first

Answer 149

Familiar object (key, coin)

Answer 150

Ability to recognize numbers, symbol Letter traced on the palm

Answer 151

An inability to recognize objects by touch, suggests a parietal lobe lesion

Answer 152

Eyes closed •Point location * •Touch an area on the patient’s skin and withdraw the stimulus * •Ask the patient to point to the location you lightly touched * •Prefered test by provider (quick) •Two-point discrimination * •Distance at which the patient can no longer distinguish two points * •Varies with body parts •Extinction phenomenon * •Simultaneously touch two areas on each side of the body * •Similar sensations should be felt bilaterally * •Patient should be able to discriminate the number of touches

Answer 153

* Select a properly weighted hammer * Encourage the patient to relax; * Hold the reflex hammer loosely * brisk direct movement; use the minimum force needed to obtain a response * Use reinforcement when needed * Grade the response 0-4+

Answer 154

Plantar reflex Abdomen reflexes Cremaster reflex Anal wink

Answer 155

* Stroke the lateral side of the foot from the heel to the ball and then curve across the ball of the foot to the medial side * Patient should have plantarflexion of all toes * Babinski sign is present when there is dorsiflexion of the great toe * Indicates pyramidal tract disease

Answer 156

A, Biceps. B, Brachioradial. C, Triceps. D, Patellar. E, Achilles. F, Evaluation of ankle clonus.

Answer 157

1- Have the patient's elbow at about a 90° angle of flexion with the arm slightly bent down as shown in figure 2-6. 2- Grasp the elbow with your left hand so the fingers are behind the elbow and your abductee thumb presses the biceps brachial tendon. 3- Strike your thumb a series of blows with the rubber hammer, varying your thumb pressure with each blow until the most satisfactory response is obtained. 4- Normal reflex is elbow flexion (bending)

Answer 158

* Grasp the patient's wrist with your left hand and pull his arm across his chest so the elbow is flexed about 90° and the forearm is partially bent down. * Tap the triceps brachial tendon directly above the olecranon process. The normal response is elbow extension.

Answer 159

* Strike the brachioradialis tendon on the lateral side of the forearm * Apply your finger over the area and strike the hammer on your finger * Mild supination of the hand, wrist extension and flexion of the elbow

Answer 160

* Tap the Achilles tendon and the foot should extend from the contraction of the gastrocnemius and soleus muscles responding to that tap. Perform the reflex test in this manner: * Have the patient sit on a table or bed so that his legs dangle. * With your left hand, grasp the patient's foot and pull it in dorsiflexion (upward). Find the degree of stretching upward of the Achilles tendon that produces the optimal response. * Tap the tendon directly. * Normal response is contraction of the gastrocnemius and plantar flexion of the foot.

Answer 161

* Biceps reflex (C5-6) * Brachioradial (C5-6) * Triceps reflex (C6-8) * Supinator or brachioradialis (C5-6) * Patellar reflex (L2-4) (May need interlocking hands to distract) * Ankle reflex (primarily S1-and L5) Please correct * Clonus, a hyperactive response required for assigning a reflex grade of 4, usually elicited at the ankle * Superficial reflex * Cremasteric (T12; L1-2) * Plantar (L5; S1-2)

Answer 162

Neck mobility Brudzinski's sign Kernig's sign

Answer 163

•Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.

Answer 164

•Severe stiffness of the hamstrings and inability to straighten the leg when the hip is flexed to 90 degrees

Answer 165

Legs and feet extended with plantar flexion and arms rotated and flexed on chest. Decorticate posture may progress to decerebrate posture, or the two may alternate. The posturing may occur on one or both sides of the body.

Answer 166

Arms stiffly extended and hands turned outward and flexed, leg also extended with plantar flexion Decorticate posture may progress to decerebrate posture, or the two may alternate. The posturing may occur on one or both sides of the body.

Answer 167

•Static problems develop at any age and do not get better or worse (e.g., nerve deafness and some trauma)

Answer 168

•Degenerative problems occur when function is lost and it progressively worsens

Answer 169

* Multiple sclerosis * Progressive autoimmune disorder characterized by a combination of inflammation and degeneration of the myelin of the brain’s white matter leading to decreased brain mass and obstructed transmission of nerve impulses

Answer 170

•Gradual, but unpredictable, progression, with or without remissions

Answer 171

•Physical: * Weakness * Gait disturbance * Foot drop * Hyperesthesia or paresthesia * Cerebellar dysarthria (scanning speech) * Spasticity (especially in lower extremities) * Positive clonus, Babinski.

Answer 172

•Episodic abnormal electrical discharges (excessive concurrent firing) of cerebral neurons may be caused by: * CNS disorder * CNS structural defect * Disorder that affects functioning of the CNS •Examples include brain injury, toxins, stroke, brain tumor, or hypoxic syndromes

Answer 173

* Stroke (brain attack or cerebrovascular accident) * Sudden interruption of blood supply to a part of the brain or the rupture of a blood vessel, spilling blood into spaces around brain cells * Ischemic * Hemorrhagic

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•Myasthenia gravis is a Peripheral Nervous System disease * •Autoimmune disorder of neuromuscular transmission * •Usually proximal to distal progression

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Fatigability

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* Fluctuating weakness, often subtle, that worsens during the day and after prolonged use of affected muscles, may improve with rest * Early symptoms are transient with asymptomatic periods lasting days or weeks. * \>50% of patients present with ocular symptoms (ptosis and/or diplopia). Eventually, 90% of patients with MG develop ocular symptoms. * Ptosis might be unilateral, bilateral, or shifting from eye to eye.

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•Autoimmune-mediated destruction of peripheral nerve myelin sheaths and inflammation of nerve roots

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* Occurs following a nonspecific gastrointestinal or upper respiratory infection 1 to 3 weeks earlier or following an immunization * Distal to proximal progression * Typical features are distal sensory changes followed by progressive motor weakness and areflexia.

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* unsteady gait which may be due to sensory ataxia, facial weakness, diplopia, leg or back pain, or sensory changes in the extremities. * Paresthesia and pain typically occur in a stocking/glove distribution, frequently early in the course. * Most patients first note leg weakness or gait instability that progresses over days to weeks. 60% are unable to walk at the peak of symptoms. * Characteristic findings include muscular weakness and sensory changes, most often symmetric with distal greater than proximal involvement

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•Recurrent paroxysmal sharp pain that radiates into one or more branches of the fifth cranial nerve

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•Disorder of the peripheral nervous system that results in motor and sensory loss in the distribution of one or more nerves * Diabetes mellitus * B12 deficiency * Lyme disease * HIV infection

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•Permanent non-progressive (adult stage) disorder of movement and posture development

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* Assess for more than one type of neurologic impairment: * Spasticity: increased tone/reflexes/clonus * Dyskinesia: abnormal movements * Hypotonia: decreased tone * Ataxia: abnormal balance/coordination

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* Delayed motor milestones * Abnormal tone * Abnormal neurologic exam suggesting a cerebral etiology for motor dysfunction * Absence of regression (not losing function) * Absence of underlying syndromes or alternative explanation for etiology

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•Congenital defect of one or more vertebrae (commonly the lumbar or sacral) that permits a meningeal sac filled with a portion of the spinal cord to protrude

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* Best prevented by taking a daily dose of folic acid * As soon as you suspect pregnancy before confirming it, please, please start the mother on folic acid 400 mg po daily

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* Severe form of child abuse resulting from the violent shaking of infants under 1 year of age * Stretching and tearing of nerve tissue and blood vessels causes brain damage and a subdural hematoma * Spinal cord may also be damaged

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* Slowly progressive, degenerative neurologic disorder * Deficiency of the dopamine neurotransmitter results in poor communication between parts of the brain that coordinate and control movement and balance

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•First signs usually a mild resting tremor unilateral presentation

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A complete neurological assessment consists of : * Cranial nerves * Proprioception (feeling and self in space and balance) and cerebellar function * Sensory function * Reflex function

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No motor component See the light

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Motor component Pupil constricts

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Tic Douloureux A condition affecting the largest nerve in the face that provides sensation. Only sensory not motor. Described as the worst pain known to mankind.

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Loss of NL fold and a respiratory illness precedes it

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The fact they can feel the stick in the back of the throat and the raising of the uvula

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Swallowing

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Sense of self in space and gait.

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* Ability to develop theories * Ability to use logical reasoning * Ability to make future plans * Ability to use generalizations * Ability to consider risks and possibilities

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education, intelligence, and experience.

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HEADSS assessment (Home, Education/Employment, Activities, Drugs, Sexuality, Suicide)

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60 or 70 years of age.

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•30 years of age

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•Verbal skills and general knowledge continue to increase into the 60s and often remain stable into the 80s.

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remote memory

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Mnemonic for Depression SIGECAPS (associated factors to depression: oldcaArts * S sleep disorders * I interest (anhedonia – no interest) * G guilt (worthlessness, regret, hopelessness) * E energy deficit * C concentration * A appetite * P psychomotor retardation or agitation(irritability) * S suicidality

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* Conducted within context of age, developmental level, and cultural norms * Appearance: Affect, posture, hygiene and grooming, body habitus * Behavior: Verbal/nonverbal expressions of pain, anxiety, emotions, interactions, activity level, body movements and mobility * Cognition: Oriented to time, person, and place, attention and concentration, pattern and pace of speech, judgment, memory, mood

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* Homicidal ideation (HI) * Suicidal ideation (SI) * Identify protective factors If there is a DD of mental health you have to ask about suicidal ideations

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* S sleep disorders * I interest (anhedonia – no interest) * G guilt (worthlessness, regret, hopelessness) * E energy deficit * C concentration * A appetite * P psychomotor retardation or agitation(irritability) * S suicidality * Must have experienced at least five of the symptoms for the previous two weeks to be diagnosed with a MDD!!!!

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Assess mental health during the general survey or if there is a past medical history

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* Mental health conditions: * Depression * Depressed phase of bipolar disorder—inquire if prior mania, family or personal history of bipolar disorder, prior agitation, or excitement with antidepressant medication. * Adjustment disorder with depressed mood * Substance abuse-related mood disorders * Medical comorbidity: adrenal diseases, anemia, hypothyroidism, diabetes, hypercalcemia, liver or renal failure, malignancy, sleep disorders, chronic fatigue syndrome, fibromyalgia, lupus * Neurologic or cognitive disorders such as neurodegenerative CNS disease, dementia, or delirium * Deficiencies: vitamin B3, Vitamin D, vitamin B12, or folate

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1. Identify risk factors 2. Identify protective factors 3. Conduct suicide inquiry 4. Determine risk level/intervention 5. Document

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Psychic pain/anxiety Psychiatric diagnosis; Prior Suicide attempt Agitation; Comorbidity; Firearm access; Hopelessness

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Mini-Mental State Examination (MMSE) - most studied Mini-Cog - three unrelated words, clock face

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Anyone over 65 should have one A score up to 24 is NORMAL Score of 20 is MILD

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1- Get your patient’s attention and have them repeat 3 unrelated words to you. You may repeat words up to 3 times to make sure patient has register each one. Leader, season, table. 2- Ask the patient to draw a clock face with all the numbers on it then and set the time at 10 past 11. You may repeat instructions as needed. If patient cannot complete the clock in 3 minutes (score zero) and move to the next step 2 points if correct, with all numbers inside the circle, right sequence and right time. And Zero point if incorrect 3- Recall 3 words. 1 point for each word correctly recalled **Interpretation:** **0-2 = positive screen** **3-5 = negative screen but does not rule out completely cognitive impairment** **A score of 3 or less: patient needs to be evaluated further.**

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Catatonia: group of symptoms that usually involve a lack of movement and communication, and also can include agitation, confusion, and restlessness. Often present in schizophrenic patients – talking to a statue then super agitated

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Akathisia (Greek “not to sit”) is an extrapyramidal movement disorder consisting of difficulty in staying still and a subjective sense of restlessness.

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Pressured speech: characterized by rapid, compulsive talking, is a classic symptom of hypomanic and manic episodes in people with bipolar.

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Apathetic: * stop caring about everyday tasks, hobbies, or personal interests * struggle to show interest and enthusiasm in others * feel indifferent to spending time with others * experience very little emotion or changes in mood

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Elated mood: state of heightened joy, exaggerated optimism, and restless excitement. Indicative: drug induced, schizophrenia, psychosis, mania.

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Labile mood: characterized by sudden, rapid changes in mood not congruent to the stimuli.

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Concrete thinking: “cognition that reflects experience, rather than abstraction, typical of those who are unable to generalize.” AKA literal thinking

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Circumstantial thought: the use of many words where fewer would do AKA Circumstantiality: speech characterized by indirection and delay due to the patient’s excessive use of details that have no connection to the point

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Tangentiality: phenomenon in which a person constantly digresses to random, irrelevant ideas and topics, never answering the original questions.

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Loose associations AKA Derailment: a person shifts topics with no apparent relation between the topics, The frame of reference often changes from one sentence to the next. Thought derailment is a symptom of schizophrenia

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Echolalia: repeat noises and words they hear instead of expressing their thoughts. For example, instead of answering a question, they may repeat the question.

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Flight of ideas: similar to derailment but much faster in speed, close to manic. “people to speak rapidly and quickly shift between loosely connected ideas when speaking. Speech is pressured, quick, at time incoherent, speak so fast they may slured their speech, but for them, they make complete sense. Schizophrenia.

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Perseveration: persistent repetition of words or ideas even when another person attempts to change the topic. Talking about a grievance over and over, and won’t stop even when provider wish to change the subject. common symptom of early Alzheimer's disease

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Clangassociation : speech in which word choice is governed by word sound rather than meaning; word choice may show rhyming or punning associations. Example: He rained the train brain strain gain the crane.”. Bipolar, schizophrenia,

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Blocking: interruption of speech while ostensibly in pursuit of a goal

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•Word salad: Incoherence (word salad, schizaphasia): severe lack of speech cohesion at the basic level of syntax and/or semantics within sentences. Advanced Schizophrenia. Example” Run desk making dinner sunglasses menu”

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Magical thinking/delusion: similar: the belief that one's ideas, thoughts, actions, words, or use of symbols can influence the course of events in the material world. Magical thinking presumes a causal link between one's inner, personal experience and the external physical world.

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Poverty of speech: a common symptom of schizophrenia, and may co-occur with poverty of content – assoc depression

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Neologism: the creation of new "words"

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Illusion: misinterpretation of a correct sensory input. For example, a child who perceives tree branches at night as if they are monsters.

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Impulse control disorders: condition in which a person has trouble controlling emotions or behaviors. Often, the behaviors violate the rights of others or conflict with societal norms and the law.

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Judgement: The ability to make considered decisions or come to sensible conclusions. “what would you do if you saw a fire in a movie theater?”

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Insights: the capacity to gain an accurate and deep intuitive understanding of a person, situation, event.

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•Rotational forces cause a transient disruption in the reticular neurons that maintain alertness * Sports injuries * Motor vehicle accidents * Falls

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* Impaired cognition, consciousness, mood, and behavioral dysfunction of acute onset * Risk factors * Serious illness * Injury * Preexisting cognitive decline Fluctuating mental health

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•Brain’s response to withdrawal from alcohol consumed in large quantities over time• ## Footnote Delirium tremens signs include agitation, confusion, combativeness, panic, seizures, hallucinations, and illusions

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* Common psychiatric disorder associated with a neurochemical imbalance * Symptoms from mild to major depressive disorder are characterized by feelings of helplessness and hopelessness and recurrent suicidal thoughts

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* Persistently elevated, expansive, or irritable mood lasting longer than 1 week, one phase of the bipolar disorder * Associated with a neurochemical imbalance, an increased level of monoamines

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•Group of disorders with such marked anxiety or fear that it causes significant interference with personal, social, and occupational functioning Associated with abnormalities in the norepinephrine and serotonin systems

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* Schizophrenia * A severe, persistent, psychotic disorder with relapses throughout life * May be associated with fetal neurodevelopmental defects: * Viral infection during pregnancy * Prenatal nutritional deficits * Perinatal complications

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**_DSM 5:_** Two or more of the characteristic symptoms below are present for a significant portion of time during a one-month period (or less if successfully treated): ## Footnote * •1. Delusions * •2. Hallucinations * •3. Disorganized speech (eg, frequent derailment or incoherence) * •4. Grossly disorganized or catatonic behavior * •5. Negative symptoms, ie, affective flattening, alogia, or avolition

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* A neurobehavioral problem of impaired attention and hyperactive behavior affecting 5% to 10% of school-age children * Theorized that dopamine system disturbances may be associated with ADHD onset

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•A chronic, slowly progressive disorder of: * •Failing memory * •Cognitive impairment * •Behavioral abnormalities * •Personality changes * Often begins after 60 years of age * Usually related to structural diseases of the brain

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* Approximately 60% of cases * May be caused by abnormal processing or deposition of amyloid

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* Approximately 5% to 10% of cases * Reduced cerebral blood flow such as a brain infarct(s)

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* Associated with diffuse Lewy bodies in the brain * Parkinson disease * Frontal lobe degeneration AKA Pick’s dementia

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* Prefrontal cortex: Responsible for complex cognitive processes and not fully mature until young adulthood * Adolescents have increased vulnerability to substance use disorder

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* Routine: rapid screen for Tobacco, ETOH, and drug abuse * Patient presents with specific complaints * Patient is seeking highly addictive medications * Patient admits with s/s of drug abuse, withdrawal.

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* Step one: In social history * Rapid screen: One question: * Tobacco: Do you smoke-\> pack/year * ETOH: Do you drink. Yes-\> how much how frequent. * If above limit: 2 standard drinks for men, and one for women daily, rapid screen is positive -\>administer appropriate screening tool * FYI upper limit is less for senior: 1 standard drink for men or women, may drink up to 3 drink equivalent on accession not to exceed 7 drink equivalent a week * Prescription/illicit drugs:•“How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reasons?” Any positive answer requires further more extensive screening

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the legal limit for drunk driving is a blood alcohol concentration (BAC) level of **_0.08._** If patient weight less than 200 pounds he/she will reach BAC level after **_two standard drink_**

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Objective finding (even though it is a patient report)

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Screening CAGE AID: ETOH and other drugs

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All types of substance abuse

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Drug abuse

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* Administer PHQ9 (depression) GAD 7 for anxiety * For elderly patient might be useful to administer MMSE or minicog

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* Engaging: Used throughout assessments, including when resistance is encountered * Focusing: Attention to a patient problem and goal * Evoking: Process of evoking change talk from patients * Planning: Guiding the individual to form a concrete plan of action

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* Important components of MI include empathizing and empowering the individuals to take steps toward change and affirming their strengths. * Provider must be genuine, honest, show empathy * Provider use open-ended questions, validation and affirmation and use of reflective listening

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Advise Agree Arrange Assess Assist

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•DSM-5 criteria for addiction and nonsubstance addictive behaviors * •Assess for behaviors causing personal, emotional, social, financial, spiritual, or legal harm to individuals

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* Stage 1: Precontemplation is when an individual is not yet considering change or is unwilling or unable to change. * Stage 2: Contemplation occurs when the possibility of change is recognized but one is ambivalent and uncertain. **•Stage 3: Preparation or Determination is the stage in which the individual is committed to changing _within 30 days_ but is still considering what to do.** * Stage 4: Action includes taking steps toward change but the change is not yet stabilized. * Stage 5: Maintenance is the stage in which goals have been achieved and efforts are focused on maintaining the change. * Stage 6: Recurrence is defined as experiencing a recurrence or relapse of the old behaviors and deciding what to do next.

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Increased bone reabsorption